the thoughts of a surgeon in the notorious province of mpumalanga, south africa. comments on the private and state sector. but mostly my personal journey through surgery.

Saturday, February 09, 2008

assistants

assisting isn't rocket science. it's not difficult. you basically need to give the surgeon exposure. if you can't do this, then just do what he tells you. that's all.

having said this, to work with a good assistant is amazing. a good assistant can predict what is going to happen next and get everything lined up so it all just goes that much easier.

as a student i assisted quite a bit. as a junior doctor i assisted a fair amount. as a registrar i assisted after hours for extra money. i can assist and therefore i can direct and teach a poor assistant. in fact, for me the ideal assistant is an inexperienced one that i can train and develop to my specifications. but i also use young doctors because they are the ones that need the money. they are the ones that work for the state and are underpaid. i remember how i needed money in those days and therefore i usually use these doctors. the practice that i work for has occasionally basically requested that i use the older gps but i feel a certain obligation to the state doctors.

but, especially when i am trying to favour those who need the money, nothing irritates me more than having to phone a whole bunch of people before i get an assistant. i mean when someone says they are on call or out of town, then i have no problem, but when they say they are tired or have a headache or need their beauty sleep or whatever they tend to fall to the bottom of the list of people i call. i recently was told by one of my assistants that another guy was wondering why i phone him so seldom. i didn't say anything, but i thought of all the times i did call him and he wasn't available because of 'social obligations'. it's at times like this that i realize i can be a typical surgeon. i don't want to know about inconvenience and the like. i just want an available assistant at midnight when i have a gunshot abdomen who is decompensating.

i recently lost two great assistants (they moved to canada where they are presently freezing). so now i am trying to reestablish an assistant base.

but it can be difficult to assist (unless it is your passion). no matter the time of day or night and no matter how little sleep you've had in the last week, when you are operating, all your senses are sharp. you are fully alert. you are fully alive. but to simply hang on a retractor at 3 in the morning while the surgeon works his magic can be mind numbing. and mind numbing when fatigued means sleep and sleep means poor assisting.

except the exceptions. many years ago while i was a medical officer in surgery (before i officially started specializing) we had a house doctor who had a special talent. awake he wasn't a particularly good assistant but in the early hours, he would hook the morris into the wound, push his feet up against the table, throw his head back and fall asleep. in this position he gave such good exposure the surgeon would demand total silence just in case someone woke him up.

7 comments:

i love that last paragraph. i fell asleep, or at least nodded, when an intern, but i doubt i kept the exposure. having a great assistant is a soaring experience. in fact i stuck around in my first job longer than i should have -- not enough to do, wife not happy -- because i had a perfect relationship with my partner. i thought he was the best surgeon i knew and he thought the same of me and we were a great team no matter on which side of the table we stood. my very second post on my blog was about the art that can happen with a good assistant. and i'd be happy to help you. little bit of a logistic thing, but still...

if the patient isn't stable, i somehow don't think you'd get here on time.

interestingly enough, i prefer assisting with the slightly less experienced. maybe i'm too self conscious. maybe i know that all surgeons believe they can do it better and therefore get irritated. i learned to do nissens with a guy who did it skin to skin in 10 minutes (perfectly). the first one i did with him assisting me took about an hour. i think he was biting his bottom lip to keep from telling me to bugger off so he could get the thing done.

the other thing that i didn't touch on is the hierarchy in theater. there can be only one surgeon (not unlike the highlander). recently i was doing a trivial something and my assistant, trying to be helpful, asked if she could try to help me. it had never happened before and it better not happen again ;)

Good post. It's tough to be a good assistant when you are "trying" to take over the case. I've had assistants let go of the retractor to "sponge" a bleeder. Then I couldn't see to take care of the actual bleeder. Not good.

Bongi, thank you so much for the mention. I will have to learn that "morris position", sounds like it would come in handy on occasion. I wish I could become part of your assistant base. That would be awesome!Since assisting is my life, I never have social obligations. My favorite trauma surgeon once told me, "You know, you can say no, or that you are just too tired." To which I replied, "You will probably never hear the words, I'm too tired, come out of my mouth."

Watching the relationship between surgeon and assistant is one of the most fascinating parts of time spent in the OR, I think. It's such a big difference between when the chemistry is there and when it's clearly not.

I've often seen an operation run smoothly with a nurse assisting and when a second surgeon arrive to assist, everything gets complicated.

A situation which seems to be very optimal is when a resident is operating and a senior surgeon is assisting and guiding. I envy that institutionalized way of learning from your seniors.

I'm happy to assist and 'predict' the surgeons next move. The money is just a bonus. We've been together for 6 years but the wife and I have never assisted each other until recently. She did a case and asked if I would like to assist her. Seeing as though I was her lift home I thought it would at least pass the time while I waited. She didn't like it as I 'predicted' her too much. I thought she could hurry it up so I could get home in time to watch 'The Simpsons'. Needless to say, we never 'assisted' one another again.

Bongi, please blog about your most enigmatic, colourful, entertaining assistant affectionately known as 'blind-chicken-boy'. I'm sure your readers would love to hear of his antics. Even now I smile at the recollection of some of his triumphs.

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the aim of this blog is to give insight into the mind of a particular surgeon, me. although every story is loosely based on fact, patients have been changed suitably to protect their identity. the opinions expressed are mine alone and are not meant to be considered medical advice or the opinion of any institution.